Earlier this winter, we sat down with one of our new Board of Directors and new members, Dr. Harold Carter. As the Chief Pharma Trade Relations Officer at Express Scripts, Dr. Carter has spent years leading value-based solutions strategies for the company. He brings a unique understanding of both the healthcare system and the importance of understanding what is meant by “value” in healthcare.
Thank you so much for taking the time to speak with us today. Could you tell us a little about your background and how you came to connect with IVI?
I am a pharmacist by training and have spent my entire professional career in managed care. In my work, I’ve had significant opportunities to learn about how we manage drugs through both the pharmacy and medical benefit. Over the past few years, I’ve focused on how we look at not just the cost of the drug, but the value of the drug from a macro perspective.
When I thought about joining the Board at IVI, I saw an organization that is working to assess value in its purist form – an unbiased enterprise that is working to include all the pieces that go into assessing value. I felt like I could bring the payer perspective to the Board to help ensure that value assessment becomes more relevant and useful to payers.
Nobody is against value, even if we are all using the word “value” to mean different things. So how do you measure value meaningfully?
“Value” should account for more than whether a patient responds to treatment. For instance, what are the most important factors to measure to account for value? This can be incredibly subjective, depending on what you measure and for how long. Or, what are the right endpoints? For payers, they might get into arrangements where the cost to measure the value of a treatment is more than the treatment itself! I’ve spent a lot of my career trying to figure out how to streamline the assessment of value to make it simple, predictable, and affordable.
And while there is a push to look at costs across 5, or even 15, years down the line, health plan members usually turn over more frequently. So, some of these value-based arrangements are nearly impossible to validate.
What do you think is the most important or exciting opportunity that you see around value assessment?
I am really excited about some of the novel therapies that are coming to market. Some of these treatments have the potential to be transformative for people’s health and in how we assess value. For example, gene therapy may be incredibly expensive at the outset, but how would you measure the value of something that is curative?
I also think that value assessment has the potential to help payers, especially employers, to capture the big picture of value. Good value assessment would capture not just medication costs, but also days off from work, hospital visits, and sick days. I think some of these newer treatments can help decision-makers navigate and understand both their short-term and long-term savings.
What is an example of what happens when we get value assessment wrong?
If you get value wrong, the patient and his or her family pays the true price, right? If value assessors claim that there is no return on investment to a given treatment and that is wrong, then it could lead to payers to be less likely to cover a treatment. In healthcare, there is a huge marketplace risk, and the unintended consequences can be devastating. The same is true for claiming a very high return on investment. Those patients don’t get the expected outcomes and healthcare dollars aren’t allocated appropriately.
How do you see IVI as contributing to the advancement of value assessment?
What I like about IVI is that it takes a methodical and transparent way of building its economic models. Folks may criticize you for your methods, but by taking feedback from others thoughtfully, they can still see the insides of the watch, if you will.
In addition, I do think that IVI can make value assessment easier for plan sponsors to understand and leverage. Value assessment is so complex, we need to construct it in a way that makes sense to more than just HEOR experts.
I would like to invite our community to start using what I call the “Grandma Litmus Test” when talking about value assessment. When I try to explain my work to my 85-year-0ld grandma, and she says, “Oh honey, that’s nice,” then I know I need to change my approach. IVI is doing incredible work, and the Grandma Litmus Test can help make value assessment more relevant and understandable for everyone.
Thank you Dr. Carter. That is incredibly insightful, and I think your litmus test is the one we all need to use.
